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1. Field of the Invention
The present invention relates to a method and apparatus for endoscopic surgical (endo-surgical) introduction and application of surgical sheet material.
2. General Background of the Invention
Surgery performed within a body cavity (e.g., chest cavity, abdominal cavity) by means of endoscopic surgery utilizes of one or more surgical entry xe2x80x9cportsxe2x80x9d in varying size. The majority of sizes is in the range of five (5) millimeters to fifteen (15) millimeters, but may be as small as approximately two (2) millimeters. Each port consists of a tube with proximal and distal ends. A valve structure on the proximal end of the port member allows instruments to be passed through the body cavity wall while maintaining appropriate intra-cavity CO2 (or other gas) pressure (if such pressure is required).
While instruments pass easily through the associated port member and its valve structure, sheet like material, liquids, gels, and like medicinal materials cannot be easily administered in endoscopic surgery.
In endoscopic surgery, there are or will be a variety of sheet material, liquid, gel and like medicinal materials that require application in the body cavity (including the pelvis). Because these products have specific medical purposes (example: adhesion prevention and as a drug delivery vehicle) the application will have to be precise (to targeted areas or tissues) as opposed to the general way irrigating solutions are administered to wash or rinse tissues during surgery. Also, because these products will be expensive they cannot be wasted and precise application is desired.
A number of patents have issued for surgical instruments some of which contemplate endoscopic deployment. For example, U.S. Pat. No. 5,304,187 issued to David Green et al., and entitled xe2x80x9cSurgical Element Deployment Apparatusxe2x80x9d, provides an apparatus which facilitates endoscopic deployment and positioning of surgical elements adjacent to body tissue for subsequent securement thereto. The surgical element is wound within a tubular sleeve and then extruded from the distal end of the tubular sleeve. A method is also disclosed for deploying and positioning surgical elements using the apparatus of the present invention.
The Pietrafitta U.S. Pat. No. 5,295,952, entitled xe2x80x9cSwab For Laparoscopyxe2x80x9d discloses a swab that comprises an outer generally tubular shank with a handle or gripping end and a working end. An inner shaft is slidably received in the shank and has a working end and a gripping end. A changeable, disposable absorbent tip is operably connected to the working end of the shaft. The swab includes a biasing means at the gripping ends of the shank and shaft for urging the absorbent tip toward the gripping ends.
In the Shlain U.S. Pat. No. 5,263,927, entitled xe2x80x9cApparatus And Methods For Dispensing Surgical Packingxe2x80x9d, a surgical packing dispenser is disclosed that comprises an elongate tube having a housing mounted on its proximal end. A continuous roll of sterilized packing material is disposed within the housing, and a free end of the packing material extends distally through the tube. The sterilized packing material is mounted on the spindle, and a handle is provided to rotate the spindle to feed material from the roll down the dispenser tube. In this way, relatively lengthy amounts of the packing material can be dispensed during laparoscopic and other endoscopic surgical procedures.
In the Villasuso U.S. Pat. No. 5,257,973, entitled xe2x80x9cSealing Sleeve And Method For Laparoscopyxe2x80x9d, a sealing sleeve is disclosed for use with a cannula in open laparoscopy. The sleeve of the subject invention has a conical shaped collar defining a passageway for feeding the cannula there through. The collar is formed of a resilient medically inert material capable of conforming to the edges of an incision thereby forming a gas tight seal and maintaining the pneumoperitoneum during the laparoscopy. The sleeve also includes a polygonal tube connected to the collar and rigid supports attached to the polygonal tube for receiving a suture to maintain the cannula in place with respect to the patient.
The Casale U.S. Pat. No. 5,310,407, entitled xe2x80x9cLaparoscopic Hemostat Delivery System And Method For Using Said Systemxe2x80x9d, discloses a delivery system and method for inserting hemostatic material through a channel of a laparoscopic cannula, and for directly applying the material to an internal tissue site, includes a hollow sheath having a cross-section and configuration that permits sliding passage thereof through the channel of the laparoscopic cannula. The sheath is charged with hemostatic material, and the hemostatic material is advanced through the lumen of the sheath and mechanically applied at the tissue site by an applicator. The hemostatic material may be in the form of compressed loose fibers, a sponge, a powder, a paste, a sheet, or a combination thereof, and may be composed of resorbable collagen.
The present invention provides an improved instrument for endoscopic surgical insertion and application of surgical sheet material. The present invention also provides a method of placing surgical sheet material into a patient""s body cavity such as, for example, the abdominal cavity, chest cavity, or the like.
The present invention provides an endoscopic surgical instrument that includes an outer elongated instrument body having an open ended bore and proximal and distal end portions. An inner elongated instrument body fits inside the bore of the outer instrument body, the inner instrument body having proximal and distal end portions, at least the distal end portion being flexible or articulated.
A flag member is mounted to the distal end of the inner instrument member, the flag member being sized and shaped to support a sheet of surgical material to be placed within the body cavity of a patient.
An optional articulating joint is provided at the distal end portion of the outer instrument body. The combination of the distal end of the inner instrument body and the flag furled about the distal end can be fitted within the bore of the outer instrument body of the distal end portion thereof. Means is provided for deploying the distal end of the inner instrument member beyond the distal end of the outer instrument member so that the flag can be opened to deploy the sheet of material inside the patient""s body cavity.
The joint is preferably an articulating joint that can include a pivot.
The flag member is preferably a plastic material having a memory (or a preloaded cartridge) so that it automatically opens when the flag is discharged beyond the distal end of the outer instrument body into the patient""s body cavity. This action opens the flag and presents the sheet of material to the proper location within the patient""s body cavity.
The outer instrument body has a slot that receives the flag member so that the flag member can be furled about the inner instrument member and inside the bore of the outer instrument member by rotating the inner and outer instrument members in opposite relative rotational directions.
A clamp can be provided for holding an edge of the sheet of surgical material on the flag next to the inner instrument member.
The clamp is preferably a U-shaped member that fits the instrument member for gripping the edge of the surgical sheet material that the surgeon places on the flag.
A trigger mechanism is provided for pulling the clamp from the flag in order to release the sheet material from the flag once inside the patient""s body cavity.
The inner instrument body can be provided with a plurality of openings, preferably linearly arranged. The openings can be subjected to suction for holding the material to be dispensed to the inner instrument member. The material to be dispensed can then be released by releasing the suction. The openings can also function as dispensing openings for dispensing a volume of liquid (such as normal saline). The liquid (e.g. saline) flows through the holes causing the sheet like material to xe2x80x9cfloatxe2x80x9d off, or detach from the flag member. This feature may be required when the sheet like material is stuck to the flag member by a small static or van der Waal type interaction present between the material and the flag. When using the linearly arranged openings, the U-shaped clamp or hood may not be required.